| Growing evidence in several professional fields supports that women's vulnerability to HIV is not only the result of socioeconomic factors, but also the outcome of a cumulative history of cultural influences that have shaped mutually exclusive, specific roles for both men and women. In heterosexual relationships, social normalization of gender roles explains the limited power that women perceive on communicating about sexuality with their partners, demanding fidelity, seeking self-protection in sexual intimate encounters, or negotiating condom use; and this is regardless of their level of education. In the Dominican Republic (DR), the HIV infection has been feminized due to the 'macho' culture, which encourages men to be promiscuous and unfaithful, but discourages condom use. On the contrary, the culture encourages women to be faithful to their husbands, but discourage sexual communication. Consequently, Dominican women have limited access to means of protection and condom negotiation with their sexual partners. The mainly heterosexual nature of the HIV epidemic in the DR requires a deep understanding of the role of and the associations between social and cultural factors to define power imbalance and gender dynamics that result in women's and perhaps men's vulnerability to HIV. The purpose of the current study is to understand gender inequalities in HIV risk among adults 15 to 49 years old in the DR, and to understand women's vulnerability to the infection. Two main aims have been proposed. First, the study aims to examine and contrast the impact of several gendered power indicators on sexual behaviors among men and women. Second, the study intents to examine and contrast the impact of gendered power indicators on sexual behaviors and HIV-related attitudes among currently married and formerly married women. Cross-sectional population data from the Demographic and Health Survey [DHS] collected in the DR in 2007 was analyzed. Descriptive survey analysis and nested logistic regression models were completed. Our results for goal 1 indicated that women were less likely to use a condom than men (OR=0.30, p<0.001). Among men, higher education, better wealth, and living in a female-headed household increased the likelihood to use a condom. In comparison with never married men, currently married and formerly married men were 97% and 33% less likely to use condoms. Among women, the odds of condom used increased for young adults 15-19 years old (OR=1.32, p<0.001), but decreased up to 64% as age groups grow older. Being in the richer quintile (OR=1.26), living in a female-headed household (OR=1.26), and having good access to media (OR=1.24) increased the likelihood of condom use. However, being currently married or formerly married and living in rural areas decreased such likelihood (p<0.001). Being a women reduced the likelihood of premarital sex by 94% (p<0.001). Older age, higher education, and better wealth status increase the odds of condom use among men (p<0.001). Men who were younger, have rural residence, and agreed with traditional gendered expectations were less likely to have premarital sex. Among women, only higher education (OR=1.25, p<0.001) and agreeing with both men and women can have sex before marriage (OR=1.30, p<0.001) increased the likelihood of premarital sex; however, living in rural areas was found protective in comparison with women living in big cities (p<0.001). Results for goal 2 indicated that formerly married women were 6.7 times more likelihood to use condoms than currently married women (p<0.001). Among currently married women, being 20 to 24 years old, working in sales, living in a female-headed household, and having good access to media increased the likelihood of condom use (p<0.001). Among formerly married women, however, higher education and working on sales increased the likelihood of condom use by 73% and 23%, respectively (p<0.001). The likelihood of condom acquisition was similar both currently married and formerly married women (OR=1.05, p>0.005). Among currently married women, however, the odds of condom acquisition increased with higher education, wealth, occupation, access to media, and acceptance of abstinence for both men and women (p<0.001). Among formerly married women only higher education and occupation increased the likelihood of condom use. Older age was found to decrease condom for both currently and formerly married women in comparison with 30 to 34 years old currently married women. Our study has provided the evidence to support that gender differences of power and sexual behaviors among the Dominican population call for tailored, gender-specific interventions that accounts for the specific needs found among men and women; even within the female population, prevention strategies needs to account for current marital status and identify the best ways to strength the sources of power for each group of women. (Abstract shortened by UMI.). |
